An Arthroscopic (Key-hole) Treatment of Tennis Elbow

Tennis Elbow is a common cause of lateral sided elbow pain. Contrary to the given name, many sufferers of tennis elbow do not necessarily play tennis.

The diagnosis is usually straight forward. The area of the tennis elbow pain can be identified with one finger and it is usually on the outer bony prominence of the elbow. This pain is worsened by extending the wrist against resistance with the elbow straight.

The person suffering from tennis elbow will have difficulty lifting heavy loads and many simple activities of daily living can potentially trigger the pain as the wrist joint usually need to be extended during most activities.

Treatment of Tennis Elbow include:

Pain killers and oral anti-inflammatory medications.

Steroid injection into the painful area.

Physiotherapy.

Use of counterforce elbow brace.

Extra-corporeal Shockwave Therapy (ESWT).

Injection of PRP (Platelet Rich Plasma).

Dry needling of the painful area to stimulate healing.

Surgery.

The traditional surgery for tennis elbow involves a 3 to 4cm incision over the outer aspect of the elbow centred over the painful area and the diseased tendon causing the pain (called the ECRB tendon) is found after cutting through normal ECRL muscle and tendon.

The elbow will need to be rested in a splint for about 2 to 3 weeks. The person is unable to work for about 2 to 3 weeks.

I prefer a minimally invasive key-hole surgery approach.

Arthroscopic Treatment of Tennis Elbow

This procedure is done under general anaesthesia and it takes about 25 to 30 minutes to complete.

It involves making 2 small puncture holes (about 3mm in size) on either side of the elbow joint.

A small TV camera (called the arthroscope) is inserted into the elbow joint from the inner aspect. A 2nd small hole is made on the outer aspect of the elbow joint to allow a shaver device to be inserted into the elbow joint.

This shaver allows me to remove a small portion of the joint capsule to expose the diseased ECRB tendon near the insertion into the lateral epicondyle. The diseased ECRB tendon is carefully removed with the shaver.

The elbow can be moved almost immediately after this surgery. The time off from work is markedly reduced from a couple of weeks to just a few days.

Case Study:

This is a right handed 32 year old man who works in the Logistics line. He has right tennis elbow pain for over a year. He has had one steroid injection a year ago which provided him with 3 months of pain relief. The pain recurred and became gradually worse. He had a second steroid injection a month ago but the pain did not improve.

An MRI scan of his right elbow showed a partial tear of his common extensor tendon at the lateral epicondyle.

He was agreeable for an arthroscopic treatment of his right tennis elbow.

This is a video showing the surgery as well as the outcome at 6 days after the surgery.